The Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) estimates that drug-resistant germs kill more than 40 percent of individuals with serious infections, and they tend to have a higher kill-rate among patients with weaker immune systems, including the elderly and young children.

In 2008, FDH found that a drug-resistant bacteria had infected ten people in Broward County in a single month, leaving seven of them at one long-term care hospital. The bacteria, now referred to as CRE (Carbapenem-resistant Enterobacteriaceae), had a mortality rate of 69 percent. Officials warned that healthcare professionals must take safety measures to limit the spread of germs from hospitals and nursing homes to the general community. “The speed at which the epidemic…is spreading in our healthcare system mandates urgent action,” said top control experts in a scientific journal.

Five years later, on 4 June 2014, Florida health officials are requiring laboratories to report cases of CRE. CDC director Dr. Tom Frieden has said of CRE, “it can resist all antibiotics, kill a high proportion of people it infects, and spread from person-to-person and bacteria-to-bacteria readily.” Pharmaceutical firms have not invested in a drug to prevent the spread of CRE, so healthcare officials are relying on coordinated prevention measures among area hospitals. “Prevention is the only real option with these germs,” said epidemiologist Dr. L. Silvia Munoz-Price of Jackson Medical Center in Miami. Officials now recommend healthcare workers to practice regular hand-washing, and disinfection of shared medical devices, both of which are standard protocols.

FDH has not released the name of hospitals involved in the twelve CRE outbreaks, and state lawyers have denied public disclosure requests, pointing to an exemption in the open-records law for epidemiological investigations. Hospitals themselves are not motivated to publish that they have highly resistant germs in their facilities, and the state law which requires outbreaks of any germ to be reported have been enforced loosely. In the past five years, Florida’s Agency for Healthcare Administration, which licenses and inspects hospitals, has cited only one hospital for failing to report an outbreak, said agency spokeswoman Shelisha Coleman.

State officials are unaware of how widespread drug-resistant germs are, but a 2011 Duval County Health Department survey found that eight of ten hospitals within the county received reports of 113 CRE cases. Other drug-resistant germs are spreading in Florida’s hospitals, and until now lack of compliance with infection control protocols has made it difficult to reduce the spread.

Effects of experimental exclusion of scavengers from anthrax-infected herbivore carcasses on Bacillus anthracis sporulation, survival and distribution

By Steve E. Bellan1, Peter C.B. Turnbull2, Wolfgang Beyer3 and Wayne M. Getz4,5

¹Center for Computational Biology and Bioinformatics, University of Texas at Austin, Austin, Texas, USA

²Salisbury, UK

³Universität Hohenheim, Institut für Umwelt-und Tierhygiene, Stuttgart, Germany

⁴Department of Environmental Science, Policy & Management, University of California, Berkeley, California, USA

⁵School of Mathematical Sciences, University of KwaZulu-Natal, Durban, South Africa

Source: http://aem.asm.org/content/early/2013/04/08/AEM.00181-13.abstract
Abstract

Scavenging of anthrax carcasses has long been hypothesized to play a critical role in the production of the infectious spore-stage of Bacillus anthracis after host death, though empirical studies assessing this are lacking. We compared B. anthracis spore production, distribution and survival at naturally occurring anthrax herbivore carcasses that were either experimentally caged to exclude vertebrate scavengers or unmanipulated. We found no significant effect of scavengers on soil spore density (p > .05). Soil stained by terminally hemorrhaged blood and by non-hemorrhagic fluids exhibited high levels of B. anthracis spore contamination (ranging from 10³–10⁸ spores per gram) even in the absence of vertebrate scavengers. At the majority of carcass sites, we also found that spore density in samples taken from hemorrhagic-fluid stained soil continued to increase for longer than 4 days after host death. We conclude that scavenging by vertebrates is not a critical factor in the life cycle of B. anthracis and that anthrax control measures relying on deterrence or exclusion of vertebrate scavengers to prevent sporulation are unlikely to be effective.

Read the full paper at: http://aem.asm.org/content/79/12/3756.full.pdf+html
Some comments from promedmail.org:

Firstly, not all infected species are equicompetent at shedding/leaking infected body fluids. In this study, they tried with a springbok carcass but rejected it when no spores were found in its soil samples. Over the years, we have had a very similar experience with white tailed deer anthrax carcasses; I have sampled the soil under some 10 deer carcasses and never had a positive recovery; others have had identical experiences. On the other hand, I have never seen such a gross leakage as this study described with zebras. With cattle carcasses, I frequently see a bovine shaped spread of grease under the carcass and maybe blood at where the nose and anus would have been, and only there viable spores might be found. Thus, zebras and springboks/white tails are the alpha and omega of carcass leakers.

As white tails are the major affected deer species in west Texas -- the ranch we do most of our research on has over 800 deer and only some 3 dozen aodads -- so _B. anthracis_ must find some way of
supporting new deer outbreaks most years. Deaths are not reported in their aodads. The ranch soil is a typical alkaline steppe soil.

The paper does not mention which scavenger species fed on the carcasses, though it lists possibles. In my experience, vultures or turkey buzzards will find a carcass within minutes, and a gang of them will quickly and efficiently eviscerate it. African vultures are well described doing the same, and in doing so, they efficiently and significantly reduce the risk and extent of any soil contamination; passage through their intestines kills any and all vegetative _B. anthracis_ cells; one year, we had a deer outbreak with some 2 dozen deaths, and the buzzards fed on the carcasses, and when I sampled their faeces under their roost, there was not one positive faecal sample in the 20 cultured. Vulture faeces will be positive if they feed on an old carcass where sporulation has already occurred. And beyond a threshold number of deaths, the vultures are replete, and then ignore the new dead deer.

If you are going to have soil contamination from scavengers, it must depend on how they attack the carcass. Maximal soil contamination would logically be from a fresh anthrax carcass with maximum bloody fluid, e.g., ascites, spillage. Lions having ripped the carcass open dine together. Foxes, whether in northern Canada or Argentina, tunnel in. Wolves are very untidy feeders, from what I have seen about wood bison carcasses. Hyaenas come late and drag off pieces and limbs, as do coyotes. Feral hogs and mountain lions are carcass draggers.

In an area with frequent zebra anthrax cases, one might expect to see a genomic shift in the pathogen to maximize the volume of fluids, bloody and otherwise, shed from a zebra carcass. And late fluids even

if with no viable organisms might act as nutrients for the early 1^st deposited soil-cycling anthrax organisms’ later if not immediately. Plus they would fertilise the forage to attract grazing animals back
to this contaminated site at a later date.

What I am trying to say is that this is not a simple situation. It is one overdue for analysis and investigation, as we have a triad of factors: host species and potentials for postmortem fluid leakage or

not; scavenger species and feeding habits; and pathogen factors. In addition, confirmation is needed on what happens within the typical target species not just in the 1st 4 days but up to 8 to 10 days
postmortem in relation to, for example, numbers of surviving viable organisms within the carcass, pH, and the internal aerobic-anaerobic status. It is possibly not as simple as tradition would have it,
though probably not widely different. It needs recalibration.

One last point, when sampling soil repetitively, flag each sample site. It is all too easy to revisit old, previously sampled sites, ignore other parts, and get distorted results. I speak from

experience. - Mod.MHJ
As many as 75 CDC scientists exposed to anthrax after violation of handling procedure

Source: http://www.homelandsecuritynewswire.com/dr20140619-as-many-as-75-cdc-scientists-exposed-to-anthrax-after-violation-of-handling-procedure

June 19 – The Centers for Disease Control and Prevention (CDC) said earlier today (Thursday) that as many as seventy-five scientists working in CDC laboratories in Atlanta, Georgia may have been exposed to live anthrax bacteria after researchers deviated from established pathogen handling procedures.

The scientists are now being treated to prevent infection. The New York Times reports that so far none of the scientists has exhibited any symptoms.

The exposure occurred after researchers working in a high-level biosecurity laboratory located at the CDC’s Atlanta campus failed to follow proper procedures to inactivate the bacteria. They compounded this initial error by moving the samples, which may have included live bacteria, to lower-security CDC labs not equipped to handle live anthrax. Scientists working in the lower security lab do not wear the protective gear necessary when handling live anthrax bacteria.

Thomas Skinner, CDC spokesman, said that “the likelihood that anyone was actually exposed is very small.”

Dr. Paul Meechan, director of the environmental health and safety compliance office at the CDC, was quoted by the Guardian to say that the CDC discovered the potential exposure on the evening of Friday, 13 June, and immediately began contacting individuals who worked in the labs who may have handled live anthrax bacteria.

“No employee has shown any symptoms of anthrax illness,” Meechan said.

Meechan added that the normal incubation period can take up to five to seven days, though in some cases the incubation period may be as long as sixty days.

Meechan said that it was likely that only seven researchers may have directly handled the live anthrax, but the agency is casting as wide a net as possible to make sure all employees at the agency who may have walked into any of the labs at risk are being offered treatment.

He said that around seventy-five individuals are being offered a 60-day course of treatment with the antibiotic ciprofloxacin, as well as an injection with an anthrax vaccine.

Meechan told the Guardian it is too early to determine whether the transfer was accidental or intentional.

He said that all employees who were doing procedures to inactivate the bacteria were working in a highly secure biolab and were “tier one select agent approved,” meaning that they had undergone a security reliability review and deemed to be “stable, trustworthy individuals.”

Meechan added that the CDC is conducting an internal investigation to discover how the exposure occurred and said disciplinary measures would be taken if warranted.

“This should not have happened,” he said. For those exposed, he said, “We’re taking care of it. We will not let our people be at risk.”

EDITOR’S COMMENT: Perhaps this is the second incident worldwide after the Sverdlovsk anthrax leak in 1979.

Sverdlovsk anthrax leak

Source: http://en.wikipedia.org/wiki/Sverdlovsk_anthrax_leak

The Sverdlovsk anthrax leak was an incident in which spores of anthrax were accidentally released from a military facility in the city of Sverdlovsk (formerly, and now again, Yekaterinburg) 1450 km east of Moscow on April 2, 1979. This accident is sometimes called "biological Chernobyl".The ensuing outbreak of the disease resulted in approximately 100 deaths, although the exact number of victims remains unknown. The cause of the outbreak had for years been denied by the Soviet Union, which blamed the deaths on intestinal exposure due to the consumption of tainted meat from the area, and subcutaneous exposure due to butchers handling the tainted meat. All medical records of the victims had been removed in order to avoid revelations of serious violations of the Biological Weapons Convention.

Background

The closed city of Sverdlovsk had been a major production center of the Soviet military-industrial complex since World War II. It produced tanks, nuclear rockets and other armaments. A major nuclear accident happened in this region in 1957, when a nuclear waste facility exploded (known as the Kyshtym disaster), resulting in the spread of radioactive dust over a thousand square kilometers. The biological weapons facility in Sverdlovsk was built after World War II, using documentation captured in Manchuria from the Japanese germ warfare program.

The strain of anthrax produced in Military Compound 19 near Sverdlovsk was the most powerful in the Soviet arsenal ("Anthrax 836"). It had been isolated as a result of another anthrax leak accident that happened in 1953 in the city of Kirov. A leak from a bacteriological facility contaminated the city sewer system. In 1956, biologist Vladimir Sizov found a more virulent strain in rodents captured in this area. This strain was planned to be used to arm warheads for the SS-18 ICBM, which would target American cities, among other targets.

The accident

The produced anthrax culture had to be dried to produce a fine powder for use as an aerosol. Large filters over the exhaust pipes were the only barriers between the anthrax dust and the outside environment. On the last Friday of March 1979, a technician removed a clogged filter while drying machines were temporarily turned off. He left a written notice, but his supervisor did not write this down in the logbook as he was supposed to do. The supervisor of the next shift did not find anything unusual in the logbook, and turned the machines on. In a few hours, someone found that the filter was missing and reinstalled it. The incident was reported to military command, but local and city officials were not immediately informed. Boris Yeltsin, a local Communist Party boss at this time, helped cover up the accident.

All workers of a ceramic plant across the street fell ill during the next few days. Almost all of them died in a week. The death toll was at least 105, but the exact number is unknown as all hospital records and other evidence were destroyed by the KGB, according to former Biopreparat deputy director Ken Alibek.
The investigation

In the 1980s, there was vigorous international debate and speculation as to whether the outbreak was natural or an accidental exposure. If accidental, there was discussion of whether it represented violation of the 1972 Biological Weapons Convention. A number of small investigations launched by Russian scientists in the years immediately following the dissolution of the Soviet Union re-opened the case in a number of newspaper articles.

A team of Western inspectors led by Professor Matthew Meselson of Harvard finally gained access to the region in 1992, and determined that all of the victims had been living directly downwind at the time of the release of the spores via aerosol. Livestock in the area were also affected. It was revealed around this time that the accident was caused by the non-replacement of a filter on an exhaust at the facility, and though the problem was quickly rectified it was too late to prevent a release. Had the winds been blowing in the direction of the city at that time, it could have resulted in the pathogen being spread to hundreds of thousands of people. The military facility remains closed to inspection. Professor Meselson's original contention for many years had been that the outbreak was a natural one and that the Soviet authorities were not lying when they disclaimed having an active offensive bio-warfare program, but the information uncovered in the investigation left no room for doubt. Meselson's wife, Jeanne Guillemin (who had participated in the investigation), detailed the events in a 1999 book.
Aftermath

Russian Prime Minister Egor Gaidar issued a decree to begin demilitarization of Compound 19 in 1992. However, the facility continued its work. Not a single journalist has been allowed onto the premises since 1992. About 200 soldiers with Rottweiler dogs still patrol the complex. Classified activities were moved underground, and several new laboratories have been constructed and equipped to work with highly dangerous pathogens. One of their current subjects is reportedly Bacillus anthracis strain H-4. Its virulence and antibiotic resistance have been dramatically increased using genetic engineering.

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